Fill and Sign the Az Child Support 497297243 Form

Person Filing: Address (if not protected): City, State, Zip Code: Telephone Numbers: Email Address: ATLAS Number: Representing [ ] Self or [ ] Lawyer for Lawyer Bar Number: SUPERIOR COURT OF ARIZONA IN COUNTY Case Number: Petitioner CHILD SUPPORT ORDER Respondent THE COURT FINDS that: 1. , Petitioner , and , Respondent , owe a duty to support the following child(ren): Name Date of Birth Arizona Supreme Court Page 1 of 11 DRS81F-120816 Revised March 2016 FOR CLERK USE ONLY Case Number: 2. CHILD SUPPORT GUIDELINES: The required financial factors and any discretionary adjustments pursuant to the Arizona Child Support Guidelines are as set forth in the Parent’s Worksheet for Child Support, attached and incorporated herein by reference. 3. CHILD SUPPORT: [ ] [ ] Petitioner [ ] Respondent is obligated to pay child support to [ ] Petitioner [ ] Respondent in the amount of $ per month pursuant to the Arizona Child Support Guidelines without deviation. [ ] [ ] Petitioner [ ] Respondent is obligated to pay child support to [ ] Petitioner [ ] Respondent in the amount of $ per month pursuant to the Arizona Child Support Guidelines without deviation. This amount is an appropriate amount to award for child support in this case except that the Court finds it more appropriate and just to make a rounding adjustment to the exact guideline amount for ease of calculation to $ per month. [ ] [ ] Petitioner [ ] Respondent is obligated to pay child support to [ ] Petitioner [ ] Respondent in the amount of $ per month pursuant to the Arizona Child Support Guidelines. Application of the child support guidelines in this case is inappropriate or unjust. The Court has considered the best interests of the child in determining that a deviation is appropriate. After deviation the child support order is $ per month. [ ] [ ] Petitioner [ ] Respondent is obligated to pay child support to [ ] Petitioner [ ] Respondent in the amount of $ per month pursuant to the Arizona Child Support Guidelines. Application of the child support guidelines in this case is inappropriate or unjust. The Court has considered the best interests of the child in determining that a deviation is appropriate. After deviation the child support order is $ per month. Further, the parties have entered into a written agreement or their agreement is on the record and is free of duress and coercion with knowledge of the amount of child support that would have been ordered under the guidelines but for the agreement. Reason(s) for deviation: Arizona Supreme Court Page 2 of 11 DRS81F-112916 Revised March 2016 Case Number: 4. SUPPORT ARREARS: [ ] [ ] Petitioner [ ] Respondent owes child support arrearages to [ ] Petitioner [ ] Respondent in the total amount of $ for the time period of through plus accrued interest on prior child support arrearages due of $ calculated through the date of . [ ] The court finds no child support arrearages due and owing. [ ] No evidence was presented in support of child support arrearages. 5. PAST SUPPORT: [ ] It is appropriate to award [ ] Petitioner [ ] Respondent an additional judgment for past support in the amount of $ for the period between the filing of this current petition and the date current child support is ordered to begin. [ ] Temporary support or voluntary / direct support payments in the amount of $ were paid during the period above; therefore the past support is adjusted to $ . [ ] It is appropriate to award [ ] Petitioner [ ] Respondent an additional judgment in the amount of $ for past support owed from the date of separation, but not more than three years before the date of filing the current petition. [ ] Temporary support or voluntary / direct support payments in the amount of $ were paid during the period above; therefore the past support is adjusted to $ . [ ] The court finds no past support amount due and owing. [ ] No evidence was presented in support of past child support. Arizona Supreme Court Page 3 of 11 DRS81F-112916 Revised March 2016 Case Number: [ ] The court finds no temporary support or voluntary / direct support payments were paid. [ ] No evidence was presented in support temporary support or voluntary / direct support payments. Arizona Supreme Court Page 4 of 11 DRS81F-112916 Revised March 2016 Case Number: IT IS ORDERED that: A. CHILD SUPPORT: [ ] [ ] Petitioner [ ] Respondent shall pay child support to [ ] Petitioner [ ] Respondent in the sum of $ per month payable by income withholding order on the first day of each month commencing . B. SUPPORT ARREARAGES JUDGMENT: [ ] [ ] Petitioner [ ] Respondent is granted judgment against [ ] Petitioner [ ] Respondent in the sum of $ as and for child support arrearages for the period of through the date of together with interest on said sum at the legal rate of 10% per annum until paid in full plus additional accrued interest on prior child support judgments of $ calculated through the date of . [ ] Petitioner [ ] Respondent shall pay, in addition to [ ] his [ ] her current support payment, the sum of $ per month toward this judgment, payable on the first day of each month commencing until paid in full. [ ] No judgment for child support arrearages is entered. C. PAST SUPPORT JUDGMENT: [ ] [ ] Petitioner [ ] Respondent is granted a past support judgment against [ ] Petitioner [ ] Respondent in the additional amount of $ . [ ] Petitioner [ ] Respondent shall pay the additional amount of $ per month toward this judgment, payable on the first day of each month commencing until paid in full. [ ] No judgment for past support is entered. D. PAYMENTS AND CLEARINGHOUSE: All payments, plus the statutory handling fee, shall be made through the Support Payment Clearinghouse pursuant to an Order of Assignment or Income Withholding Order signed this date. Any time the full amount of support ordered is not withheld, the obligor (the party being ordered to pay) remains responsible for the full monthly Arizona Supreme Court Page 5 of 11 DRS81F-112916 Revised March 2016 Case Number: amount ordered. Payments not made directly through the Support Payment Clearinghouse shall be considered gifts unless otherwise ordered. All payments shall be made payable to and mailed directly to: Support Payment Clearinghouse PO Box 52107 Phoenix, AZ 85072-2107 Payments must include the [ ] Petitioner’s [ ] Respondent’s name and ATLAS number. Pursuant to A.R.S. § 25-322, the parties shall submit current address information in writing to the Clerk of the Superior Court and the Support Payment Clearinghouse immediately. The obligor (party being ordered to pay) shall submit the names and addresses of his or her employers or other payors within 10 days. Both parties shall submit address changes within 10 days of the change. E. TOTAL MONTHLY PAYMENTS: [ ] Petitioner [ ] Respondent shall make total monthly payments to [ ] Petitioner [ ] Respondent of $ per month payable on the first day of each month commencing as follows: Monthly Payments: Current child support payment as ordered above: $ Current spousal maintenance payment: $ Support arrearage payment: $ Clearinghouse handling fee: $ 5.00 Total monthly payment: $ F. MEDICAL, DENTAL, AND VISION INSURANCE FOR THE MINOR CHILD(REN) (A.R.S. § 25-320(J)): [ ] [ ] Petitioner [ ] Respondent shall be individually responsible for providing medical insurance for the minor child(ren) and shall continue to pay premiums for any medical, dental and vision policies covering the child(ren) that are currently included in the incorporated Parent’s Worksheet for Child Support . Arizona Supreme Court Page 6 of 11 DRS81F-112916 Revised March 2016 Case Number: [ ] [ ] Petitioner [ ] Respondent shall be individually responsible for providing medical insurance for the minor child(ren) of the parties as soon as it becomes accessible and available at a reasonable cost, as neither party currently has the ability to obtain such medical insurance. Medical, dental, and vision insurance, payments and expenses are based on the information in the Parent’s Worksheet for Child Support attached hereto and incorporated by reference. The party ordered to pay must keep the other party informed of the insurance company name, address and telephone number, and must give the other party the documents necessary to submit insurance claims. An insurance card must be provided to the other party. Notification must also be provided to the other party if coverage is no longer being provided for the child(ren). G. NON-COVERED MEDICAL EXPENSES: [ ] Petitioner is ordered to pay % and Respondent is ordered to pay % of all reasonable uncovered and/or uninsured medical, dental, vision, prescription and other health care charges for the minor child(ren). A request for payment or reimbursement of uninsured medical, dental and/or vision costs must be provided to the other party within 180 days after the date the services occur. The party responsible for payment or reimbursement must pay their share, as ordered by the court, or make acceptable payment arrangements with the provider or person entitled to reimbursement within 45 days after receipt of the request. H. TRAVEL EXPENSES: The costs of travel related to parenting time over 100 miles away shall be shared as follows: Petitioner % Respondent % I. OTHER FINDINGS AND ORDERS: J. INFORMATION EXCHANGE: The parties shall exchange financial information such as copies of tax returns, financial affidavits, and earnings statements every twenty-four months. At Arizona Supreme Court Page 7 of 11 DRS81F-112916 Revised March 2016 Case Number: the time the parties exchange financial information, they shall also exchange residential addresses and the names and addresses of their employers unless the court has ordered otherwise. Arizona Supreme Court Page 8 of 11 DRS81F-112916 Revised March 2016 Case Number: K. TAX EXEMPTIONS. The Court allocates tax exemptions for the dependent children as follows: Child’s Name Date of Birth Party Entitled For (Month, Day, Year) to Deduction Calendar Year [ ] Petitioner [ ] Respondent [ ] Petitioner [ ] Respondent [ ] Petitioner [ ] Respondent [ ] Petitioner [ ] Respondent [ ] Petitioner [ ] Respondent [ ] Petitioner [ ] Respondent For any years following those listed above while the Child Support Order remains in effect, the parties shall repeat the above pattern of claiming deductions for each child. [ ] [ ] Petitioner [ ] Respondent may claim the allocated tax exemptions only if all support and arrears ordered for the year have been paid by December 31 of that year. An Internal Revenue Service form 8332 may need to be signed and filed with a party’s income tax return. See IRS Form 8332 for more detailed information. https://www.irs.gov/pub/irs-pdf/f8332.pdf [ ] [ ] Petitioner [ ] Respondent may unconditionally claim the tax exemption allocated to [ ] Petitioner [ ] Respondent for income tax purposes. An Internal Revenue Service Form 8332 may need to be signed and filed with a party’s income tax return. See IRS Form 8332 for more detailed information. https://www.irs.gov/pub/irs-pdf/f8332.pdf L. MODIFICATION: If this is a modification of child support, all other prior orders of this Court not modified remain in full force and effect. Arizona Supreme Court Page 9 of 11 DRS81F-112916 Revised March 2016 Even though the court’s judgment contains orders regarding medical insurance and the allocation of the right to claim the child as a dependent for the purposes of federal taxes, these orders are not binding on the IRS. Under the Affordable Care Act, the party who claims a child as a dependent on a federal tax return has the obligation to ensure that the child is covered by medical insurance and may be penalized by the IRS for failing to do so. This penalty may be imposed even if it is the other party’s responsibility to carry medical insurance on the child under the Decree of Dissolution of Marriage. Case Number: M. EMANCIPATION: A child is emancipated:  On the child’s 18th birthday, however if a child is still attending high school or a certified high school equivalency program, support will continue until graduation or the child reaches 19 years of age.  On the date of the child’s marriage.  When the child is adopted.  When the child dies. Date Judicial Officer Typed or Printed Name of Judicial Officer Arizona Supreme Court Page 10 of 11 DRS81F-112916 Revised March 2016 Case Number: STIPULATION (24) SIGNATURE BY PETITIONER AND RESPONDENT: By signing this document, we state to the Court, under penalty of perjury, that we have read and agree to this Order and that all the information contained in it is true, correct and complete to the best of our knowledge and belief. Date Petitioner’s Signature Date Respondent’s Signature If either party is represented by a lawyer, the lawyer(s) must sign below: Date Petitioner’s Lawyer Date Respondent’s Lawyer Arizona Supreme Court Page 11 of 11 DRS81F-112916 Revised March 2016